| NPI | 1942879663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 10089) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 132296) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19437) | |
| 104100000X Social Worker (Licence: WI 132296) | |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2025-07-09 |